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oncology > multiple myeloma > Flashcards

multiple myeloma Flashcards

1
Q

epidemiology

A

median age is 69 years
more prevalent in males and black pts

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2
Q

risk factors

A

radiation
chemicals (pesticides, herbicides, aromatic hydrocarbons and petroleum products, volatile organic compounds)
genetics (MGUS, increased w first degree relative)
obesity
suppressed immune system

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3
Q

what is multiple myeloma

A

plasma cell disorder
-antibodies created by B-cells are not functional

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4
Q

SLIMCRAB

A

sixty (>60% bone marrow plasma cells)
light chains (ratio >100)
MRI (>1 focal lesion >5mm)
calcium (serum calcium >1 mg/dL above ULN)
renal (creatinine clearance <40 mL/min or SCr >2mg/dL)
anemia (hemoglobin >2 mg/dL below LLN or <10 mg/dL)
bone (>1 osteolytic lesion)

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5
Q

consequences of bone disease

A

lytic lesions and fractures
anemia
hypercalcemia

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6
Q

initial work up

A

blood
24 hour urine
bone marrow
imaging
HIV/hep testing
serum viscosity
circulating plasma cells
echocardiogram

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7
Q

patient presentation

A

bone pain
pathologic fracture
frequent infection
anemia
rarely hyperviscosity and peripheral neuropathy

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8
Q

stage 1

A

serum beta 2 macroglobulin <3.5 mg/L
serum albumin >3.5g/dL

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9
Q

stage 2

A

not ISS 1 or 3

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10
Q

stage 3

A

serum beta 2 macroglobulin >5.5mg/L

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11
Q

Bisphosphonates- supportive care

A

bisphosphonate or denosumab therapy regardless of bone disease
-prefer denosumab in renal disease
-dental clearance before initiating
-continue therapy for 2 yearrs

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12
Q

anemia supportive care

A

erythropoietin or blood transfusions

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13
Q

infection supportive care

A

consider IVIG for patients with serious recurrent infection
-acyclovir proph for herpes zoster virus reactivation
-proph levofloxacin in newly diagnosed multiple myeloma patients

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14
Q

quick disease control while preserving bone marrow function

A

minimal residual disease leads to poorer outcomes

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15
Q

Triplet vs quadruplet regimen

A

gold standard: RVd lenalidomide (revlimid), bortezomib (velcade), dexamethasone

some patients may benefit from added daratumumab `

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16
Q

determining transplant eligibility

A

autologous transplant is preferred consolidation after induction chemotherapy
-collect enough cells for 2 transplants
*allogeneic can cure BUT high toxicity and mortality

consider:
-age
renal fxn
cardiac fx
performance status
caregiver support

17
Q

daratumumab

A

MOA: antiCD38 monoclonal antibody
give SQ over IV
Premedications:
-steroid: dexamethasone or methylprednisolone
-acetaminophen
-antihistamine: diphenhydramine
-*montelukast for 1st dose to prevent respiratory reactions
Post medications
-methylprednisolone 20 mg x2 days after each dose for 1st cycle only

18
Q

daratumumab side effects

A

infusion reactions
herpes zoster reactivation
hepatitis B reactivation

Lab interference
-SPEP/SIFE
-antibody detection test, antihuman globulin crossmatches, indirect antiglobulin tests

19
Q

bortezomib

A

MOA: proteasome inhibitor–> inhib S20 causing apoptosis
SQ not IV (bad peripheral neuropathy)
ADEs:
-herpes zoster reactivation
-thrombocytopenia
-peripheral neuropathy

20
Q

lenalidomide

A

immunomodulatory drug
ADEs:
birth defects
hematologic toxicity
thrombotic events
somnolence
increased risk of secondary malignancy
rash, skin toxicity
diarrhea
peripheral neuropathy (thalidomide)

***birth control, pregnancy tests for women of childbearing potential

21
Q

anticoagulation

A

everyone gets
highest risk within 6 months of diagnosis

risk factors
-prior VTE
-high dose steroids
-obesity
-Central or tunneled catheter
-fracture
-ImiD use

22
Q

anticoagulation therapy

A

enoxaparin 40 mg QD (preferred) or apixiban 2.5 mg BID –> partial response (50% reduction in m protein)–> aspirin 81 QD

23
Q

dexamethasone

A

MOA: induce cell cycle arrest and apoptosis
steroid side effects

24
Q

peripheral neuropathy management

A

vitamin b complex, duloxetine, or GABA analog

25
Q

elotuzumab

A

MOa IgG monoclonal antibody
In combo with lenalidomide or pomalidomide

premedication: acetaminophen, diphenhydramine, famotidine, dexamethasone

side effects: infusion reactions, thrombocytopenia, herpes zoster reactivation

26
Q

BITEs

A

step up dosing
CRS or ICANS–> subsequent doses at hospital
REMS program

27
Q

CRS

A

increased cytokines due to T cell activation –> systemic inflammatory response

28
Q

ICANS

A

disruption of the blood brain barrier and increased cytokines in CSF

treat with antiseizure meds, steroids, and supportive care

29
Q

talquetamab toxicity

A

skin related
nail related
rash related
oral
weight loss

oncology (9 decks)

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